MtF/MtX Surgeries
Breast augmentation
Breast augmentation surgery - or augmentation mammoplastiy - can be performed in order to increase breast size. It typically involves breast implants.
Three techniques are distinguishes, depending on the incision site from which the implant will be inserted after creating a cavity:
- The crease under your breast (inframammary)
- Under your arm (axillary)
- Around your nipple (periareolar)
Two types of implants are used: saline (filled with sterile salt water) and silicon (with silicon gel).
The surgey itself does not contains major risks. Post-operative risks are:
- Scar tissue that distorts the shape of the breast implant (capsular contracture)
- Breast pain
- Infection
- Changes in nipple and breast sensation (if not loss of sensation)
Another set of post-operative risks have to do with the implants themselves:
- Implant position changes
- Implant leakage or rupture
- Breast implant-associated anaplastic large cell lymphoma (a possible association has been made between breast implants and the development of anaplastic large cell lymphoma (ALCL), an uncommon cancer of the immune system)
- Breast implant illness (a set a symptoms such as fatigue, memory loss, skin rash, trouble concentrating and thinking clearly, and joint pain, that have been linked to implants)
Beside, breast implants usually have to be changes every 10 years - which means a surgery every 10 years.
FFS
FFS, or Facial Feminization Surgery is a set of different rconstructive operations performed on critical area of the face, in order to erase the typically “masculine features” of the facial bone. After assessment with the surgeons, and according to the patient’s wishes, FFS can inclue surgery of the scalp(bringing down the hair line to reduce the forehead), brows (typical male brows are more prominent), jaw, cheeks and nose. Sometimes, a “shaving” of Adam’s apple is performed at the same time. Sometimes, if many of those area will be modified, several operations are necessary. Most surgeon’s ideal is to render a “natural” look, where you cannot see that surgery has been performed. It is more concerned with erasing the masculine features than exaggerating the feminine ones. The surgery is not too risky in itself. However, the healing process can be quite long, uncomfortable and inconvenient. It is recommended to wait 12 months before assessing final results.
Vaginoplasty, vulvoplasty and orchiectomy
Vaginoplasty
Vaginoplasty is the surgical construction of outer genitalia (labias and clitoris) as well as a vagina. It aims at offering a sensitive and erogeneous organ, by keeping as many nervous endings as possible. There are four main techniques used for this surgery. In all techniques, the neovaginal cavity is “carved” in the muscle tissue between the rectum and the prostate, and the top of the glans penis is used to make the clitoris. The differences between the 4 techniques are the way to create, or “line”, the neovagina.
- Penile inversion
This is the most common technique in Europe. The neovagina is formed by inverting the penile skin, like a glove. The outside of the penis shaft becomes the vaginal lining. The deeper end of the neovagina is usually created with addition of the scrotal skin, and other skin graft if not enough skin is available. Leftovers of scrotal skin and urethra are used to create labias.
This technique is considered safest by many practictionners since it does not involve intervention at other areas (abdominal…). However, it also comes with higer risks of stenosis (atrophy and closing off of the vagina), which - in order to be prevented - necessitates life-long regular dilations of the vagina. Many surgeons insists that the final result of the surgery is 50% in the operation, and 50% in life-long post-operative care. It also comes with poor or inexistant self-lubrification. Using lubricant during penetrative sex is always necessary.
- Non-inversion
This techique is used by a few surgeons mostly in Thailand. It is similar the the penile skin inversion in the extent that it does not involve abdominal surgery, but only reuses genital tissues. The difference is that the vaginal lining is created with scotal skin (with addition of groin skin if needed), and the labias and clitoris hood with penile skin. The surgeons using this technique claim that it offers greater vaginal depth, better appearance, and improved sensations in the inner labias. The risk of stenosis, and the necessary dilation routine are the same as in a penile-inversion vaginoplasty.
- Colovaginoplasty
Colovaginplasty is a technique using a piece of the sigmoid colon to line the neovagina. The sigmoid colon is the lower, s-shaped part of the big intestestine, right before it become the rectum. Some surgeons use a piece of the the right colon instead, claiming less risks and better recovery. The piece of colon ususally comes as a complement to penile inversion: the entry of the vagina is made with reversed penile skin, and the depth is created with the colon. The piece of colon used is not completely detached from the intestine before being used for lining the neovagina. It is only a flap, that is pulled and attached, so that it remains fully vascularized.
This option is offered by some surgeons in case of lack of penile and scrotal skin tissue, preventing a classic penile-inversion technique (after orchiectomy with scrotal skin removal, or small penis), or as a corrective surgery after a penile-inversion that did not turn good. Some surgeons, however, start to propose the technique as a first intervention to people with enough penile skin, as they estimates that the risks are covered by benefits. This risk-benefit ratio remains yours to determine, according to your expectations, lifestyle, and general health condition.
It is indeed usually considered more risky, since it involves abdominal surgery. Those risks are lowered if laparoscopy (minimally invasive surgery) is used instead of open surgery. Most surgeons argue that a robotically assisted laparoscopy does not bring more safety and precision as the colon harvest technique is a simple and straightforward procedure. This does not mean, however, that an abdominal surgery is without complication.
The recovery is a bit more complicated since the colon has to be reconnected after extracting a flap (anastomosis).
The technique is, however, prefered by some people because the colon is a mucous tissue, which offers self-lubrication, elasticity, and less risk of stenosis. Frequent dilations become less important (though still encouraged, escpecaily for the vaginal entrance which is typically made with penile skin).
On the other hand, some people have reported excessive mucus secretion, forcing them to always wear a protective pad in their underwear, and others complained about foul odor from the neovagina. This problem, however, seem to be temporary, mostly in the first few weeks or months afer surgery. Another post-op complication is inflammation of the colon-made vagina, typical of operations where a portion of the colon is diverted away from the degestive system.
- Peritoneum pull-through
This technique is quite similar to the colovaginaplasty. The difference is that instead of using a colon flap to line the neovagina, it uses a peritoneum flap. The peritoneum is a mucous membrane in the abdominal cavity creating a sort of “bag” to contain and keep the organs in place.
Like colovaginoplasty, the peritoneum pull-trough technique (or PPT) usually uses penile inversion as well for the vaginal entrance (it is sometimes call PPV, or Penile peritoneal vaginoplasty). Similarly to colovaginoplasty, the peritoneum technique allows for a lighter dilation routine, less risks of stenosis, and self-lubrication. Being an elastic, lubricated membrane, some surgeons argue that the peritoneum flap is the closest thing to biovagina surgery can offer.
It brings the same risks that the colon technique, that is the risks associated with abdominal surgery. Again, those risks are lowered if laparoscopy (minimally invasive surgery) is used instead of open surgery, and even more if the laparoscopy is robotically assisted.
Vulvoplasty
Vulvoplasty is a surgical construction of the outer genitalia (labias and clitoris), without creation of a neovaginal cavity. Labias ans clitoris are created from penile tissues, like in a vaginoplasty.
The operation is shorter, with less risks and possible complications, and does not necessitate regular dilations.
Sometimes, a small cavity is created for esthetic purposes, but without enough depth to allow penetration. It aims to give a sensitive clitoris, which allows for all sex practives but penetrative sex.
A vaginal cavity can usually be created afterward if you were to decide for it. A skin graft would then be needed, either from the inner thighs, or from sigmoïd colon or peritoneum.
Orchiectomy
Orchiectomy consists in surgical ablation of the testes. Three alternatives are usually proposed:
- Ablation of the testes and the scrotum (the skin around)
- Removal of the testes and keeping the scrotal skin. It can be interesting if you’re considering a vaginplasty for later: the scrotal skin will be used, and an additionnal skin graft might not be needed.
- Removal of the testes, with keep the scrotal skin, and replace the testes with prosthetics (mostly used by cic-men who want to preserve the feeling of having testes after surgery)